Effect of intrapancreatic fat on diabetes outcomes after total pancreatectomy with islet autotransplantation
全胰切除术与自体胰岛移植后胰腺内脂肪对糖尿病结局的影响
Abstract
enBackground
Pancreatic fat may adversely affect β-cell mass and function, possibly via local release of non-esterified fatty acids, and proinflammatory and vasoactive factors released by adipose tissue. However, the effects of intrapancreatic fat in patients with chronic pancreatitis undergoing total pancreatectomy with islet autotransplantation (TPIAT) have not been studied. This study investigated whether pancreatic fatty infiltration has a negative effect on metabolic outcomes following TPIAT.
Methods
The association between pancreatic fatty infiltration and diabetes outcomes was studied in 79 patients with low or high pancreatic fat content (LPF [n = 53] and HPF [n = 26], respectively) undergoing TPIAT. Pancreatic fatty infiltration was stratified using gross examinations during isolation and validated with histomorphometry of archived histology samples.
Results
Fat area percentage in histology samples differed significantly between the LPF and HPF groups (2.1% ± 4.3% vs 10.6% ± 8.9%, respectively; P = 0.0009). Insulin dependence was more common in the HPF group, whereas more patients in the LPF group were insulin independent or on partial insulin supplementation at 1 year (P = 0.022). Furthermore, 1- and 2-h glucose concentrations during mixed-meal tolerance tests were significantly higher in the HPF group (P = 0.032 and 0.027, respectively) and β-scores (a composite measure of islet function and metabolic control) were significantly greater in the LPF than HPF group (6.1 ± 1.7 vs 4.6 ± 2.0; P = 0.034).
Conclusions
Patients with HPF were more likely to be insulin dependent, with higher postprandial glucose excursion, suggesting that intrapancreatic fat may lead to β-cell dysfunction with detrimental effects on diabetes outcomes after TPIAT.
摘要
zh背景
胰腺内脂肪可能会对β-细胞的数量以及功能产生不利的影响, 并且有可能是通过局部释放的非酯化脂肪酸以及脂肪组织释放的促炎症因子与血管活性因子所介导的。然而, 既往还没有人研究过慢性胰腺炎患者经过全胰切除术与自体胰岛移植(total pancreatectomy with islet autotransplantation,TPIAT)后胰腺内脂肪对其病情转归有何影响。这项研究调查了患者在TPIAT手术后的胰腺内脂肪浸润是否会对代谢结果造成负面的影响。
方法
在79名TPIAT手术后具有低或者高胰腺脂肪含量(分别为LPF[n=53]与HPF [n=26])的患者中调查了胰腺内脂肪浸润与糖尿病结局之间的关系。使用存档的组织学样本进行组织形态测定, 在分离与验证胰腺组织期间使用肉眼检查将胰腺内脂肪浸润进行分层。
结果
在LPF与HPF组之间组织学样本的脂肪面积百分比具有显著的差异(分别为2.1% ±4.3%与10.6% ± 8.9%;P = 0.0009)。术后第1年在HPF组中胰岛素依赖型患者较多, 反之在LPF组中有更多的患者为非胰岛素依赖型或者仅需要部分补充胰岛素型(P = 0.022)。此外, 在混合餐耐量试验中HPF组的1小时与2小时血糖浓度显著更高(分别P = 0.032与0.027), 并且LPF组的β-评分(胰岛功能与代谢控制情况的综合评分)与HPF组相比较显著更高(6.1 ± 1.7与4.6 ± 2.0;P = 0.034)。
结论
具有HPF的患者更有可能为胰岛素依赖型, 并且餐后血糖偏移更高, 这意味着胰腺内的脂肪有可能会导致β细胞功能障碍, 并且会对患者TPIAT手术后的糖尿病结局造成不利影响。
